When COVID-19 started hitting China back in Jan 2020 and in subsequent weeks, Wuhan one of the hardest hit city in China began a lockdown that lasted for 2 months or so, few in the rest of the world stopped to think that in the following months to come, various countries would be implementing some version of the lockdown seen in Wuhan.

As more and more countries started to close their borders and implement movement restrictions and social distancing measures in order to control the spread of the pandemic, people around the world started to realise how much as humans we value the physical interaction we have with each other. From shaking hands of friends and co-workers to holding hands of our loved ones or visiting our elderly parents and grandparents to meeting friends for a meal, we suddenly found ourselves living in an artificial bubble where all such interactions we took for granted have all but vanished in a span of days or weeks.

Singapore is no exception. Towards the end of March 2020, the government announced that Singapore would be placed in Circuit breaker mode which initially was supposed to last for a month but has since been extended to 1st Jun 2020. In a matter of days, all forms of social interaction outside an individual’s household would come to an abrupt halt. As the circuit breaker progress through time, reports from media started highlighting vulnerable groups in society which were originally marginalized under normal circumstances and made even more vulnerable with the circuit breaker rules.

Plight of groups of the homeless, jobless, foreign workers and the elderly were talked about much in the media. This pandemic has brought to surface the many groups of vulnerable populations in any society and has raised the indignation of many. As Pride month approaches, perhaps let us think about another group of vulnerable populations in the world – the LGBT+ community. The LGBT+ community around the world still faces various forms of discrimination – legal, religious, societal and in some cases their own family.

Just as many of the heterosexual couples who under the current circumstances who are unable to meet physically with each other, the LGBT+ couples are also faced with the same scenario. While one may argue that couples both heterosexuals and LGBT+ can use technology such as Zoom/ Facebook messenger to “see” each other, it is a poor substitute for being able to hold the hands of your loved ones while walking down a street or hug each other for encouragement. How many times when we feel low have we wished for friends or family or loved ones to just hold our hands or to brush that one teardrop off our face. How many times during our moments of joy have we felt to hug our friends or family or loved ones to share in that moment of joy. The LGBT+ community is no different from any other human. They too long for those moments.

Similarly, like many heterosexual individuals who are searching for love and hope to share their lives with their loved ones, the LGBT+ community is of no exception. As humans, we hope that in our short time on this Earth, we can share our joys and tears with our loved ones. To be able to wake up in the morning and see the face of our loved ones sleeping soundly and safely, to prepare meals for our loved ones. Even with the most mundane activity like grocery shopping as long as we have our loved ones beside us, we would feel the bliss of the moment. This again is no different for the LGBT+ community.

When the time comes for heterosexual couples that they are ready to move on to the next stage of the relationship, they would propose and register to become lawfully wedded couple. Similarly, for the LGBT+ community when they found the one whom they want to share the rest of their lives together, they too hope to be able to register to become a lawfully wedded couple. It is not just a symbolic gesture but also has legal implications. For example, when medical decisions have to made because for whatever reason the other partner is unable to do so, because LGBT+ couples are not legally recognized as next of kin, many a times they are not allowed to make decisions on behalf of their partner and the true wishes of the other partner is not being respected. It is a heart-wrenching experience faced by all involved.

For many of the LGBT+ community, they often are faced with the prospect of “coming out” to their family or friends. The numerous nights they toss and turn in bed trying to decide whether to “come out” to their family or friends. The umpteen times when they think they have decided to “come out” but yet at the last moment could not bring themselves to do so and then subsequently beating themselves over it later. This flip-flopping is not because they are ashamed of their gender identity but rather fear of hurting their family or losing friendships. Let all of us as friends and family and as society in general remove that fear. No one (heterosexual or otherwise) should feel fearful when they need to tell their family or friends of some news of their lives. As family or friends we are their safe harbour.

Some may think the fear is irrational as some family or friends may think they have not said or done anything that warrants that fear. However sometimes in our daily snippets of conversation, we have inevidently and subtly expressed our discrimination or disapproval of the LGBT+ community. For example, some of us may have said in the moment of anger or jest the word fag just as we would say the F- word, it may not nessarily suggest that we are discriminating against the gay community but to the LGBT+ community is another stab in their heart.

In a YouTube video featuring a gay couple who have found love with each other but found themselves unable to be legally married because while one of the partner lives in a country that just passed law to allow for LGBT+ marriage, it comes with restriction that if one of the partner is not a citizen of that country and is not of citizen of a country that legalized LGBT+ marriage then they still another not allowed to be married. One of the partner in the video asked poignantly, “All we want is to get married, is it that difficult?”

With talks of how this pandemic is going to change society even when the pandemic is over, I hope that part of that change will be a greater acceptance by society of the LGBT+ community where the LGBT+ community is finally able to be allowed to love without discrimination and be accepted as being part of society. The right to love and be loved should be unconditional.

Happy Pride MonthDr. Julian Ng

Dr Julian Ng has 10 years of medical practice experience. He currently serves as the Chief Medical Officer of the DTAP Group of clinics in Singapore, Malaysia and Vietnam. He is also a member of the Singapore Men’s Health Society. His special interests are in the field Andrology, especially sexual health. He is currently practising at Dr Tan and Partners (DTAP) clinic at Novena Medical Centre.

This is a very common question that I get from patients who come to see me. Some are worried about contracting STDs when giving or receiving hand jobs or masturbation from another person. Generally speaking, there is very little risk of contracting STDs from a hand job.

Even though it is low risk, it is still not zero risk. Let me share with you some points about hand jobs and STDs.

You getting the hand job VS when you’re giving the hand job

Generally hand jobs have very low risk of transmission of STDs. However, if you give the hand job, you are at lower risk of getting an STD as compared to when receiving one. Why is that? STDs tend to affect genitals more than our hands. So if you are at the receiving end, it is your genitals that are at risk. If you are giving the hand job, it is less likely for you to get STDs unless you touch your own genitals after giving the hand job.

Type of STDs that might be transmitted through a hand job

Not all STDs are transmissible via handjobs. It is usually the ones that are passed on through skin to skin contact that are transmissible.

These include:

Herpes Simplex Virus (HSV) Type 1 and 2. This usually causes painful sores or vesicles around the lips or genital areas. There is no cure for the virus but you can take antiviral medication when the symptoms appear to reduce the duration and severity of the symptoms.

Human Papilloma Virus (HPV): This virus usually causes genital warts. Warts are flesh coloured growths on the skin. There is also no treatment to treat the virus but there are different types of treatment available to remove the warts when they appear.

Molluscum Contagiosum: This is causes by a virus that lives on the skin. It can also be spread via skin to skin contact. It appears as small firm bumps on the skin which are generally harmless and painless. They usually go away on its own or you can get it removed by a doctor through freezing or laser removal.

How can you prevent it? What is considered “safe sex”?

As how we advise for all STDs, abstinence is best.

Avoid multiple partners. Keeping to one partner minimizes the risk of STDs.

Avoid high risk exposure from sex workers or those who work in massage parlours. These workers have high exposure to several people a day so you will be at higher risk.

Condoms: Condoms may provide some protection. However do take note that areas not covered by the condom is still at risk of STDs.

Get tested to be sure!

If you’re ever in doubt, or unsure of your risks and or symptoms, do seek medical advice. The doctor will be able to advise if you need to get tested or get treated.

https://i2.wp.com/www.dtapclinic.com/storage/2020/04/Can-I-Get-An-STD-From-Hand-Job.jpg?fit=1024%2C683&ssl=16831024Dr Taufiqhttps://dtapclinic.com/storage/2018/04/dtap-favicon-logo.jpgDr Taufiq2020-04-20 18:57:022020-05-15 16:03:29Can I get an STD from a hand job?

Anorgasmia as the persistent absence of attaining orgasm after sufficient sexual stimulation, which causes personal distress. Related to anorgasmia is delayed orgasm, where a person can still achieve orgasm, but with much difficulty. Delayed orgasm is seen as a less severe form of anorgasmia. These 2 conditions are on the other end of the spectrum of ejaculatory disorders, with the other side being premature ejaculation.

While definitions vary slightly from the World Health Organisation to the International Consultation on Sexual Medicine to the Diagnostic and Statistical Manual of Mental Disorders, one thing is for certain – for males who experience anorgasmia, it causes marked personal distress.

Anorgasmia can be primary or secondary. Primary anorgasmia means that the person has never achieved orgasm before. Secondary means that orgasm has been achieved in the past, but now can be reached only under specific circumstances or not at all.

The exact prevalence of anorgasmia is unknown, but numbers can range from less than 1% to more than 5% of males. What we do know is that it is more common in the older population and in people with pre-existing medical, urological, neurological or psychiatric issues.

Causes of Male Anorgasmia

Endocrinological causes include hormonal imbalances such as testosterone deficiency, hyperprolactinemia and hypothyroidism. When these hormones are abnormally low or high, they can not only impair the ejaculatory function, but the erectile function and sex drive as well.

Medications such as antidepressants (especially SSRIs), antipsychotics and opioids can also cause anorgasmia. This side effect of certain antidepressants has led to the development of a drug known as Priligy, which can delay ejaculation and is used in the treatment of premature ejaculation.

Some men obtain greater pleasure from masturbation than they do with sexual intercourse. They may continue deep-seated habits such as frequent masturbation or using idiosyncratic masturbation techniques. This hyperstimulation results in a situation where vaginal or oral intercourse may not be able to replicate the stimulation achieved through idiosyncratic masturbation. This may result in reduced penile stimulation during sexual intercourse, leading to difficulty achieving an orgasm.

Penile sensation loss has been shown to increase with age and those with sexual dysfunctions. Age-related loss of peripheral nerve conduction may account for the increased onset over age 50 years. The less sensitive your penis is, the more difficult it is to achieve ejaculation.

Anorgasmia has also been associated with multiple psychological conditions. Some of these conditions include anxiety, fear and relationship difficulties. Anxiety and fear of hurting the female, impregnating the female, childhood sexual abuse, sexual trauma, repressive sexual education/religion, performance anxiety, sexual anxiety and general anxiety are common. Anorgasmia based on a situational aspect (i.e. difficulties with a specific partner and not another) is more likely to be due to a psychological etiology.

Complications from prostate surgery (prostatectomy) or radiation therapy to treat prostate cancer can also result in anogasmia.

Diagnosis of Male Anorgasmia

Your doctor will do a thorough history and physical exam. This should include an evaluation of all medications you take or have taken in the past and past procedures and medical interventions as well.

Depending on your doctor’s evaluation, they may order further tests including blood tests to evaluate endocrine and hormonal function, sugar levels, a biothesiometry which measures penile sensitivity, a sympathetic skin test, and/ or a sacral reflex arc testing examines the spinal nerves. Imaging investigations may also be done.

If necessary, your doctor may refer you to a urologist if a physical cause is suspected or a mental health professional if it appears a psychological issue.

Treatment options

Treatment will depend on the underlying pathology.

If the cause is due to an underlying disease, management of that underlying disease is the first step in the management of anorgasmia. If the cause is due to a medication, stopping it or changing to a different medication should be considered. If there is a hormonal imbalance, it can be treated with medication to adjust the hormones.

If organic causes are ruled out, the patient may benefit from a thorough psychosexual evaluation (along with his partner). Some psychotherapy techniques that have been used are masturbation retraining/desensitization, adjustments of sexual fantasies, changes in arousal methods, sexual education, sexual anxiety reduction, increased genital stimulation, and role playing an exaggerated orgasm alone and/or with his partner.

There are some medications that have been used to treat anorgasmia, including Cabergoline, Bupropion, Amantadine and Oxytocin as some. However, these are off-label uses.

Some cases of anorgasmia have also been treated using penile vibratory stimulation (PVS) in patients with penile sensitivity loss. In PVS, a vibrator is applied to the frenular area of the glans penis to produce mechanical stimulation to trigger orgasm.

Male anorgasmia, just like with all types of sexual dysfunction, can take a significant toll on a man’s physical, psychological, and emotional life and result in significant sexual dissatisfaction, as well as that of his partner. The most important step in addressing this condition is to come to a diagnosis, rather than allowing shame, guilt or frustration to get in the way of your relationship.

The increase in social distancing and progressive lock down measures in Singapore and around the world during this COVID 19 season have prompted a big change in the way we care for our patients here at DTAP clinic.

The numbers around the world have been alarming as Spain and Italy have become the countries worst hit by the virus with over 6,000 deaths. The need to stay home and observe social distancing have slowed down the spread of COVID, not overwhelm the healthcare system and most importantly save lives.

At DTAP Clinic, we’ve made many numerous steady changes to our day to day operations to protect our staff and our patients.

This is what we have done at DTAP clinic

See our patients on an appointment basis – this means NO OVERCROWDING, in the clinic and effective social distancing

Increase frequencies of disinfecting the clinic and if a patient who saw us has any symptoms we thoroughly disinfect the clinic after the patient leaves. (Of course with the usual Personal Protective Equipment worn)

Where it is important to stay home, we are also cognizant that one can still get symptoms, need their medication refills and pick up other non covid diseases all the same.

1. DTAP TELECONSULT SERVICE:

In light of the COVID-19 situation, we are offering DTAP Teleconsult. This teleconsult service allows our current patients and new patients to connect with our doctors during clinic operating hours for non-emergency consults. After assesment and consultation, we will also deliver your medications straight to your doorstep. Learn more

That’s right, our very own teleconsult service where our DTAP clinic doctors address your health concerns as much as possible in the comforts of your own home!

If it is deemed that you need a blood, urine, swab test to further confirm your diagnosis, we would then schedule you at the next most convenient time slot, AWAY FROM OTHER PATIENTS.

And if our doctors deem that you should require medications, again you can get them via our delivery service or our pickup service, more details below.

And if our doctors deem that you should require medications, again you can get them via our delivery service or our pickup service, more details below.

2. DTAP Medication Delivery Service

Getting your medication on time is important. As part of our initiative to provide better patient care to our patients, we are now providing delivery service to your doorstep – Anywhere in the Singapore mainland. Learn more

If you need a refill of your medication prescription, or need to get treatment after your tests, or even get new meds after our doctors have diagnosed you,

Have no fear, together with our partners we deliver to your doorstep the very next day.

And of course all this is within the SS644 Singapore medication delivery guidelines, where the integrity of the medication, your personal data are fully respected and protected

So from the comfort of your own homes, you can get the essential medications you need, or if you were planning a special night with your loved one, not be caught out without your trusty blue pill even.

3. DTAP Order & Pick Up

Last but not least, for those who live and work nearby our clinics and want to drop in quickly to pickup your repeat meds, or even new medications, getting your payment done online and the items prepared would allow you to skip the queue, skip the wait and in between your busy lunch hour or schedule, you can still get your errands done, all in a heartbeat.

Stay safe amidst the current situation and remember to look out for your family and loved ones!

International Women’s Day (IWD) which is on 8th March is a global celebration of women’s achievements. On IWD, we commemorate the political, social and economic accomplishments of women and continue to strive to raise awareness about issues relating to women’s empowerment. It is both a time for celebration as well as to push for progress and change.

This year’s IWD theme is “Each for Equal. An equal world is an enabled world.”

IWD 2020 is about building a gender equal world and pushing for gender equality across various aspects of society – in the government, workplace, boardroom, media etc, and recognising that gender equality is essential for economic success and for communities to thrive. Through our individual choices and actions, we can create change and move towards a gender equal society.

At DTAP, we are firm advocates of women’s rights and empowerment. As an equal opportunity employer, DTAP believes in gender equality in the workplace and provides all employees, male and female alike, with equal opportunities to grow and excel.

As a doctor working at DTAP, I am personally proud and glad to have had the privilege of working in a supportive and nurturing work environment, where female employees can excel in their careers, whilst continuing to fulfil their equally important family roles as mothers, wives and daughters. DTAP also strives to provide a safe and friendly workplace for women, where we know that our interests are protected and are able to focus on giving our utmost best in providing patient care.

DTAP’s advocacy of women’s rights goes beyond the workplace. We have always believed in and will continue to push for equality in healthcare provision through our women’s health service. At DTAP, we support women’s right to choice through the provision of professional medical support for family planning. We also seek to enable women to take charge of their health by raising awareness and educating patients about female health issues. DTAP aims to provide a women’s health service where our female patients can feel safe, supported and empowered to take charge of their health.

As we celebrate International Women’s Day 2020, DTAP looks forward to continuing to empower women and pushing for greater awareness about women’s health issues through our women’s health service. We look forward to working together with you to forge a gender equal world.

Dr Grace has a keen interest in women’s health and has a broad range of experience from working in subspecialty departments across various tertiary hospitals, ranging from Neurology, Rheumatology, Endocrinology, Cardiology, Geriatrics Medicine to Emergency Medicine, amongst many others. She believes that communication is the key to empowering patients through facilitating a better understanding of their own health and medical issues and is always more than glad to address and allay her patients’ concerns.

“U=U: Science, not Stigma” is this year’s Singapore HIV Congress 2019 theme. The congress highlighted the ever-growing body of evidence supporting HIV testing, treatment and prevention, and on the ways in which science and stigma intersect. DTAP (Dr. Tan and Partners) clinic is proud to be part of the Singapore HIV Congress 2019 and continuously provides support to help end the transmission of HIV in Singapore by 2030 though our support of the Community Blueprint.

Dr. Jonathan Ti is a GP at DTAP @ Robertson clinic. He has a special interest in sexual health and HIV, and is a co-author of the Community Blueprint to End HIV-transmission and AIDS in Singapore by 2030, and part of the National PrEP Taskforce.

World AIDS Day is a day to remember all those who have lost their lives to the illness. At the end of 2018, it is estimated that 32 million lives were lost worldwide to the disease. WHO had previously set the 90-90-90 target for countries in the world to achieve by 2020, 90% of those living with HIV will know their status, 90% of those who are positive are on ART treatment and 90% of those who are on treatment have undetectable levels of the virus. Let us take stock of what we have been able to achieve thus far.

Since then Singapore has risen to the challenge to achieve those goals. Singapore has done well with 2 of the goals – 89% of those who are positive are on ART treatment and 94% of those who are on treatment achieved undetectable viral loads. However, much has to be done to improve on getting those living with HIV to know their status as only about 72% are aware they are positive for HIV.Thus we need to encourage more people who are at risk of HIV infection to get tested. At Dr Tan and Partners we have been strong advocates of screening of HIV and STIs for at risk persons and provide a non-judgmental and LGBT-friendly environment to discuss your concerns. This is to help to protect their families and their loved ones. It is not uncommon for people that I see in my practice to tell me one of the reasons why they are reluctant to get tested is because they are afraid of what will happen if their families or their loved ones find out.The other common concern is that they will lose their jobs. Finally there are still many misconceptions about how HIV is transmitted. I have patients who are concerned that because they share food with their families they can transmit HIV to their family which is of course not true. HIV is NOT transmitted via casual contact like sharing of food and drinks or shaking hands.

Of note in Singapore as of 2018, of all those who were tested positive more LGBTs are stepping up to get voluntary testing for HIV (20%) compared to heterosexuals (9%). Also importantly, in all newly diagnosed HIV persons in Singapore both homosexuals (42%) and heterosexuals (43%) contribute equally to number of cases. What this shows is that contrary to what some believe, HIV is NOT a homosexual disease but it is a disease that affects all sexual orientation.Finally, there is strong evidence from large studies involving thousands of sero-discordant couples (that is one partner is HIV positive and the other partner is HIV negative) who have sexual acts between 2007-2016 showed that there was not a single case of HIV transmission to the HIV negative partner if the HIV positive treated partner has undetectable levels of HIV virus. This highlights the importance of treatment of HIV, that treatment of HIV can be successful in achieving undetectable levels of virus and that transmission of HIV is effectively blocked when levels of the virus is undetectable.

We are proud that our Doctors at DTAP have been actively involved in the fight against the HIV epidemic. Our Anonymous HIV Testing site at Robertson Walk has provided a safe space for thousands of people seeking confidential HIV testing since 2005. Our Doctors were the lead and co-lead authors of the Community Workforce section in the Blueprint to end HIV transmission and AIDS in Singapore by 2030. Our Doctors were also part of the Singapore HIV PrEP Taskforce and helped write the first ever local Singapore guidelines for the clinical management of HIV PrEP.We will continue this fight until we see a world free of stigma, free of discrimination and hopefully free of HIV.

Dr. Julian Ng

Dr Julian Ng has 10 years of medical practice experience. He currently serves as the Chief Medical Officer of the DTAP Group of clinics in Singapore, Malaysia and Vietnam. He is also a member of the Singapore Men’s Health Society. His special interests are in the field Andrology, especially sexual health. He is currently practising at Dr Tan and Partners (DTAP) clinic at Novena Medical Centre.

Movember (Moustache + November) is a global movement by the Movember Foundation which puts the spotlight on men’s health, especially prostate cancer, testicular cancer, mental health and suicide prevention. The Movember Foundation recognized that males of all ages may hide their pains and suffering and ultimately result in greater problems, including an untimely demise. Unlike females, males are unlikely to share their deeply personal pains and suffering with others, including loved ones or professionals. This is why it is important for fellow males to stand up for each other, and lift them up from the fog of suffering and silence.

Cancer and Suicide – Not a pretty picture

Prostate Cancer

Prostate cancer now makes up one in seven cancers in Singapore males and is the third most common cancer now. In the five years from 2011 to 2015, almost 20% of those diagnosed with prostate cancer died. What is worse is that prostate cancer in the early stages has no symptoms at all. The earlier the cancer is diagnosed, the more likely the treatment will be successful for patients and help them remain in remission.

Testicular Cancer

While testicular cancer only accounts for 1 to 2% of all cancers in males, it is the most common cancer in young males between ages 20 to 40 – at the prime of their lives. Like prostate cancer, the earlier testicular cancer is diagnosed, the more likely that a cure is achievable. See: How to Perform Testicular Self-Exam

Suicide Prevention

More than 70% of all suicides in Singapore for 2018 were males. This is not unique to Singapore. In Australia, males accounted for 75% of suicides. The number of male suicides in Singapore is twice that of women and the majority were aged 65 years old and above. It is generally believed that many factors contributed to these statistics. Societal pressures for males to “Man Up” means that males may feel isolated and have nowhere to turn to for help. In addition, many males may feel that if they seek the help they will lose status or identity and they fear that they may lose independence, competence, control, and autonomy, all of which are perceived norms expected of males.

Mental Health

Finally, a previous study by Oogachaga(a non-profit community-based organisation that works with LGBTQ individuals) in Singapore showed that 3 in 5 LGBT individuals who participated in the survey reported facing some form of discrimination as a result of their sexual orientation. This may be part of the reason why in 2015 a study in CDC found gay and bisexual youths in the U.S. are 4 times more likely to have attempted suicide than their straight peers.

What can you do?

Pledge to walk 60 km for the month of November – for the 60 men that are lost every hour globally due to suicides.

Spend time with your buddies – be it having a night out or playing a favourite sport or whatever activity you enjoy doing together.

For the whole month of November, Dr. Tan & Partners (DTAP) is proud to support the Movember 2019 initiative with a supportive and friendly environment throughout all its clinics for men of all ages to seek help for all men’s health issues.Dr. Julian Ng

Dr Julian Ng has 10 years of medical practice experience. He currently serves as the Chief Medical Officer of the DTAP Group of clinics in Singapore, Malaysia and Vietnam. He is also a member of the Singapore Men’s Health Society. His special interests are in the field Andrology, especially sexual health. He is currently practising at Dr Tan and Partners (DTAP) clinic at Novena Medical Centre.

Request An Appointment

Speak to our doctors about your medical concerns today.

We will only be attending to essential health concerns during the circuit breaker period. Please take advantage of our teleconsult service to determine if your clinic visit is necessary. We also offer a home medication delivery service.